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Learning Objectives
Upon completion of this module, you will be able to
Define Telehealth
Identify benefits of Telehealth
Recognize barriers to Telehealth, and
Summarize strategic drivers of Telehealth
What do you think?
1.
As our population ages, our
healthcare costs rise.
True
False
3.
Often, clients or their providers need to
travel to receive or deliver health
services.
True
False
2.
In Canada, waiting times to see a doctor
when sick or in need of medical attention
are similar to those in other developed
countries.
True
False
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What do you think? Answers
1.
As our population ages, our
healthcare costs rise.
3.
Often, clients or their
providers need to travel to
receive or deliver health
services.
2.
In Canada, waiting times
to see a doctor when sick
or in need of medical
attention are similar to
those in other developed
countries.
True. In our province, the average
annual healthcare dollars spent per person in the 45-64 age range is just over $2,300; it increases steadily to over $20,000 for those 85 years and older.
Currently, 15% of BC’s population is 65 years and older; by 2036, 25% will be over 65.
False. The 2005
Commonwealth Fund International Health Policy Survey of sicker adults found that Canadians experienced longer waiting times than patients in New Zealand, Germany, Australia, United Kingdom and the United States.
True. On Vancouver Island:
There were 881 visits by specialists to remote
communities in 2011 (Ministry of Health).
8% of Telehealth clients say they would not have received care if Telehealth wasn’t available (VIHA, 2011)..
Definition
Telehealth refers to the use of communication
and information technology to deliver health
care services and information over a distance.
Telehealth transmits voice, data, images and
information, avoiding travel for patients, health
providers and educators.
Telehealth is used to deliver
client consultations
, case conferencing, remote monitoring and
education
.
Examples: New and initial patient referrals
Follow-up appointments
Client and family visits
Therapy or treatment sessions
Pre-admission and discharge planning
Triage decisions
Examples:
Client health teaching and education
Provider continuing education
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Telehealth Participants
Telehealth consultations involve
providers
and clients.
Telehealth consultations may require clinical support at
the client site to collect vital signs and assist with
examinations.
Telehealth enables collaboration among multiple
providers to discuss clients or share data and
information.
For example: physicians, nurses, therapists, and specialists.
Cardiologist, Nurse and Client participating in TeleCardiology
Examples of Telehealth
At a remote location
Psychiatrists provide psychiatric assessments.
Oncologists provide follow-up visits.
Perinatologists view live ultrasound images.
Heart specialists use a digital stethoscope to listen
to their client’s heart and lung sounds.
Dermatologists view live images of skin lesions.
Pharmacists review medications.
Pathologists examine slides and confirm diagnoses.
Speech Pathologists observe swallowing.
Opthalmologists view retinal images.
Client’s vitals are monitored at home.
TelePathology TeleHome Monitoring
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5
Strategic Drivers
There are
Limited access to health care providers due to
dispersed population and geographical diversity.
Higher mortality rates in some remote communities.
Higher emergency department visits per capita in
remote communities.
High proportion of elderly residents.
Increase in prevalence of chronic conditions
High cost and safety risks associated with travel for
physicians and clients.
History
19th Century
Telehealth can be traced to the mid 19th century when
electrocardiograph data was transmitted over telephone wires.
20th Century
In the mid 20th century, television and analogue picture transfer technology was adopted by psychiatrists to facilitate distant consultations.
1956
In 1956, Dr. Feindel, a Saskatoon neurosurgeon used a closed circuit television system to transmit live electrocorticography tracings.
1958
In 1958 Dr. Jurtras, a Montreal radiologist pioneered TeleRadiology.
2001
In 2001, Canada Health Infoway, a non profit Federal organization, contributed to the development of Telehealth in Canada.
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Telehealth Today
Telehealth is now available in all British Columbia health regions
supporting a variety of programs to many communities.
http://www.northernhealth.ca/
http://www.interiorhealth.ca/Y
ourCare/Telehealth/Pages/defa
ult.aspx
http://www.viha.ca/Telehealth
http://www.fnha.ca/
http://www.vch.ca/
http://www.fraserhealth.ca/
http://www.phsa.ca/AgenciesA
ndServices/Services/Telehealth/
default.htm
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For example:
A provider and client converse.
A provider listens to the client’s heartbeat with the help of a nurse at the client site.
Multiple providers connect to discuss a client’s case. For example:
A provider sends a dermatologist images of a client’s
skin lesions for later review.
A psychiatrist reviews a video call of a client’s interaction with a case manager.
A nurse and technologist capture and upload to a
central server several images of a client’s retina for remote opthalmologists to review.
Privacy and Security
In order to build effective client-provider relationships and meet British Columbia
legislation requirements privacy and security are secure. Telehealth uses secure
and encrypted pathways to ensure sessions are secure.
Telehealth
Meets Freedom of Information and Protection of Privacy Act (FIPPA)
standards.
Meets BC Ministry of Health privacy standards.
Has an approved Privacy Impact Assessment (PIA) and Security Threat Risk
Assessment (STRA).
Uses encryption and firewalls.
Allows secure connections provincially or out of province.
Live Interactive vs Store and Forward
Store and Forward is an asynchronous
modality where providers can review
images, information and data of the
client and respond at a
different time
based on the client’s need.
Live Interactive is a synchronous
modality that allows providers to see
and hear their clients in
real time
using Telehealth technologies.
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Telehealth Benefits
Increases service capacity and flexibility
Telehealth can enable
Scheduling flexibility for providers and clients
Regular follow-up.
Providers to reach a larger geographical
area and client base.
Better compliance for some clients. For
example, at Island Health some clients report that if Telehealth wasn’t an option, they would not have traveled for their appointment.
Improves access to health services
Remote clients and providers can access health services and
education without leaving their community.
Some clients are unable to travel due to health, family, financial or other reasons.
Weather conditions and ferry schedules can impact a client or
physician’s ability to travel.
Family can easily attend appointments and support their loved ones.
Frequent appointments are more easily attended.
Client’s health can be monitored in their own home.
Enables early triage and treatment
In urgent cases where immediate medical intervention is critical, the use of Telehealth can
Enable emergent triage allowing care to
begin immediately.
Guide stabilization before transfers.
Prevent unnecessary transfers.
Engage off-site specialists.
Examples include: TeleStroke, TeleBurn, and TeleICU.
Saves time and money
Clients using Telehealth save expenses associated with travel such as
gas, hotel stays, flights, car rentals, child care, time off work, and ambulance transfers.
Clients and providers don’t have to spend time travelling great
distances.
Inclement weather conditions can make it unsafe for clients and
providers to travel.
Increases collaboration and learning opportunities
Telehealth
Facilitates communication and relationship building among providers.
Enables access to continuing medical education (for example CME
and rounds).
Delivers program specific client education.
Reduces environmental impact
Telehealth reduces the need for travel
and therefore prevents greenhouse gas emissions.
For example, as of May 2013, Island
Health has avoided over 3.6 million kilometers of client travel, and has prevented over 977 tones of greenhouse gasses. This is comparable to parking 204 cars for an entire year!
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Economic
Telehealth requires
an infrastructure
investment of
resources and
technologies.
Cultural
Many factors
can influence a
person’s decision
to use Telehealth
Legal and Political
Telehealth may involve health
information exchange and
care provision within and
across jurisdictions. There is
a need for
Telehealth Challenges
.
Generational: the generation based
difference in technology, skill and use.
Education: the awareness of Telehealth and
its benefits.
Preference: the fit and feasibility
to integrate Telehealth into clinical workflow.
Trust in the Technology: the
reliability and consistency of the technology.
Ethnicity: the great
diversity in history, behaviors and traditions.
…common frameworks for credentialing among different jurisdictions and privileging amongst different hospitals.
…clarity regarding professional liability:
Doctor/ patient relationship, and
Malpractice and cross jurisdiction licensure.…common frameworks for Physician reimbursement.
…clinical, operational, ethical and privacy guidelines for Telehealth practice. …governance structures and vision within healthcare to support Telehealth Securing funding for employment of
clinical and technical resources to design, deploy and operate Telehealth services.
Securing funding for the acquisition and implementation of technical
infrastructure for networks and other technologies.